Stapleton 1986.

Study characteristics
Methods	Study objective: not provided Study design: randomised controlled trial Study grouping: parallel group Duration of follow‐up: not described Number of arms: 3 Single centre or multi‐site: single centre Study start date and end date: not described Setting: acute care setting
Participants	Baseline characteristics Inclusion criteria: female elderly patients with fractured neck of femur, without existing pressure ulcers, Norton score 14 or less Exclusion criteria: patients did not meet the criteria, or admitted with existing pressure sores Sex (M:F): all female patients (0:32 in large cell Ripple; 0:34 in polyether foam pad; 0:34 in Spenco pad) Age (years): mean 81 across groups Baseline skin status: mean Norton score 12.0 in large cell Ripple; 12.8 in polyether foam pad; 12.9 in Spenco pad; no existing pressure ulcers Group difference: no difference Total number of participants: n = 100 Unit of analysis: individuals Unit of randomisation (per patient): individuals
Interventions	Intervention characteristics Large Cell Ripple (Talley) Description of interventions: Large Cell Ripple (Talley) NPIAP S3I classification: powered, alternating pressure (active) air surface Co‐interventions: not described Number of participants randomised: not described Number of participants analysed: n = 32 Polyether foam pad Description of interventions: Polyether foam pad 2 feet x 2 feet x 3‐inch thickness NPIAP S3I classification: non‐powered, reactive foam surface Co‐interventions: not described Number of participants randomised: not described Number of participants analysed: n = 34 Spenco pad Description of interventions: Spenco pad NPIAP S3I classification: non‐powered, reactive fibre surface Co‐interventions: not described Number of participants randomised: not described Number of participants analysed: n = 34
Outcomes	Proportion of participants developing a new pressure ulcer Outcome type: binary Time points: not reported Reporting: partially reported Measurement method (e.g. scale, self‐reporting): graded by Borders (Grade A superficial/blister; Grade B a break in skin but no crater; Grade C a break in skin with crater; Grade D blackened tissue) Definition (including ulcer stage): patients with the development of pressure ulcers graded by Borders Dropouts: not described. Notes (e.g. other results reported): 12 of 34 in Spenco (2 Grade A/ 8 Grade B/ 2 Grade C/ 0 Grade D); 14 of 34 in Foam (1/5/3/5); 11 of 32 in Ripple (2/9/0/0) Time to pressure ulcer development Reporting: not reported Support‐surface‐associated patient comfort Reporting: not reported All reported adverse events using allocated support surfaces Reporting: not reported Health‐related quality of life (HRQOL) Reporting: not reported Cost‐effectiveness Reporting: not reported
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Quote: “patients for the first two groups were selected by lottery, and thereafter patients were allocated to each group systematically, in rotation” Comment: unclear risk of bias because it is unclear if a proper randomisation method was applied.
Allocation concealment (selection bias)	Unclear risk	Comment: no information provided.
Blinding of participants and personnel (performance bias) All outcomes	Unclear risk	Comment: no information provided.
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Comment: no information provided.
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	Comment: no information provided.
Selective reporting (reporting bias)	Unclear risk	Comment: no information provided.
Other bias	Unclear risk	Comment: no information provided.